Agents Used to Treat Anemia

Iron , Folic acid (folate) , Cyanocobalamine & hydroxocobalamin ( Vit.B12 ) , Erythropoietin (epoetin
alfa) & Darbepoetin
Iron :
-stored in the intestinal mucosal cells, liver, spleen, and bone marrow as
ferritin
-Iron is delivered to the marrow for hemoglobin production by a transport
protein, namely transferrin
-Iron deficiency leads to hypochromic microcytic anemia
-Iron deficiency anemia may cause : Pica , Koilonychias , Soreness and cracking of
the mouth
-150-180 mg/day dose for patients with iron deficiency anemia

-Acidicconditions in the stomach keep iron in the reduced ferrous form, which is the more soluble
form.
-iron is absorbed in duodenum
-The relative percentage of iron absorbed decreases with increasing doses
-so it must be taken in devided doses two or three doses
-Ferrous sulfate is Iron Oral Preparation
-Parental formulations of iron include : Iron Dextran , Sodium ferric gluconate complex , Iron sucrose
-the antidote for iron intoxication is Deferoxamine
-Fatal hypersensitivity and anaphylactoid reactions can occur with iron parental supplementation
Especially Iron Dextran

Folic acid (folate)

-reduced or active form of the vitamin (folinic acid) also known as leucovorin
calcium
-Folic acid deficiency leads to Megaloblastic anemia
-Dietary deficiency during lactation and pregnancy
-Folic acid is absorbed in the jejunum

-no side effects has been reported , oral folic acid is non toxic , excessvie amount execreted in urine and
feces

Cyanocobalamine & hydroxocobalamin ( Vit.B12 )

-Intrinsic factor is a glycoprotein produced by the parietal cells of the stomach, and it is required for
vitamin B12 absorption ( Deficiency of Intrinsic factor causes pernicious anemia and patients should take
the therapy for the remainder of life )
-In patients with bariatric surgery (surgical treatment for obesity), vitamin B12 supplementation as
cyanocobalaminis required in large oral doses, sublingually or once a month by the parenteral route
- Intramuscular hydroxocobalaminis now preferred since it has a rapid response
- vitamin B12 deficiency anemia may cause tingling (pins and needles) in the hands and feet, difficulty
walking, dementia
-

Darbepoetin
-differs from Erythropoietin by the addition of two carbohydrate chains , which improves it’s biologic
activity
-has no value in treatment of acute anemia due to their delayed onset of action
-administrated IV in dialysis patients otherwise SC
-Adverse effects include : elevation in blood pressure , arthralgia